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single wing pmp from swanfoam. why?

Discussion in 'General Issues and Discussion Forum' started by music124, Aug 27, 2016.

  1. music124

    music124 Member


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    Hi all.

    In uni we've been doing pmps out of swanfoam with a single wing. Why do we do a single wing when swanfoam is a cushioning material? Is a single wing not meant for deflecting pressure away from a site?
     
  2. davidh

    davidh Podiatry Arena Veteran

    Conventionally, yes.
    Ask your tutor.
     
  3. Dieter Fellner

    Dieter Fellner Well-Known Member

    David,

    I recall a paper, published recently (I will try to remember where to post the article) to show that single wing pads in fact increase pressure under the first. Counter-intuitive but can be rationalized. A SWP, in isolation will act somewhat like a lateral forefoot wedge.

    What are your thoughts?

    As for the choice of material. If off-loading is the intention there are better alternatives. If there is ever an anomaly, such as this, I usually follow the money line. Is foam cheaper than felt?
     
  4. wdd

    wdd Well-Known Member

    Dear Music 124,

    If you were practising on other students I would imagine you were using Swanfoam, because: there was an excess of it or it had passed its sell by date.

    You could practice cutting the correct shape and bevelling, getting any cut outs in the right place and then taping the pad in place just as well and probably less expensively with Swanfoam than with felt.

    Bill.
     
  5. wdd

    wdd Well-Known Member

    You could practice cutting the.......

    Oops practise

    Bill
     
  6. Dieter Fellner

    Dieter Fellner Well-Known Member

    I recall a time when certain individuals might severely chastise for lack of correct grammar or the occasional typo. When we now communicate in <LOL> and <TTYL> I have to wonder: is this still relevant? Or should we strive to maintain 'proper standards' and reveal to the world our real age .... I don't have the answer, but I sure don't loose sleep over it.
     
  7. wdd

    wdd Well-Known Member

    Daer Dieter,

    You are asbloulety crercot. Arapteplny for udernnantsnig all you need is to hvae the frsit and lsat lteetr in the crocrert pacle.

    Hevower wehn skipenag or tipnyg in anrocymns wrehe a slaml nmurbes of ltertes can tmsnriat a lot of imrofntoian slelnipg boceems ctiracil.

    Bset weheis,

    Blil.

    WDYD
     
  8. Dieter Fellner

    Dieter Fellner Well-Known Member

    I too used to enjoy a whiskey, or two, while posting but stopped when I sobbered up and re-read my efforts :drinks
     
  9. wdd

    wdd Well-Known Member

    Dear Dieter,

    You are absolutely correct. Apparently for understanding all you need is to have the first and last letter in the correct place.

    However when speaking or typing in acronyms where a small number of letters can transmit a lot of information spelling becomes critical.

    Best wishes,

    Bill.

    WDYD (a misspelling of 'what do you think', which could be misinterpreted as 'what do you drink' amongst others.
     
  10. markjohconley

    markjohconley Well-Known Member

    Dieter, any luck? thanks

    I'm at a loss to comprehend why a lateral forefoot wedge would increase GRF at the medial forefoot as surely a SWP wouldn't facilitate the "windlass mechanism" at the 1st ray.

    Thanks, Mark
     
  11. Dieter Fellner

    Dieter Fellner Well-Known Member

    Mark,

    Sorry, not looked yet but try googling. Also, activating Windlass would plantar flex the 1st and bingo. Increased ground reaction force.
     
  12. markjohconley

    markjohconley Well-Known Member

    Thanks Dieter, but that's my problem, a SWP would only assist 1st ray plantarflexion after heel lift unlike a lateral forefoot wedge or 1st ray cut-out ?, mark
     
  13. Dieter Fellner

    Dieter Fellner Well-Known Member

    Mark,

    What we're taught, or believe to be true intuitively, isn't always what is discovered when this is examined more closely. I'd have to see the paper again to know what design of pad. I'll keep an eye out but read this online (Foot & Ankle research maybe) in glancing only a few weeks / months (?) ago. I remember thinking 'there goes another podiatry myth' (there are many). Also, a foot may respond variably. Can we ever know accurately what we do unless we can have access to technology, such as F-scan?
     
  14. Cameron

    Cameron Well-Known Member

    netizens

    This issue typifies of the chicken and egg argument which is regularly found in podiatry. A little history might help to make things a bit clearer. The introduction of soap based adhesives revolutionised the chairside approach to foot care back in the 1930s. It gave added armour to the clinician who could now stick a pad on to the skin. There was no evidence to support the action but it appeared to make sense and in the absence of an alternative proved popular with those practitioners keen to offer their clients 'a better service'. The original padding was cumbersome and tricky to work and the true mark of a competent practitioner was their scissor action and bevelling. Unlike today, the materials were much thicker and difficult to cut. It was soon realised shaping the padding to meet foot contour assisted fit and more particularly allowed the client to wear it. Most would end up in the bin anyway. Teaching being teaching or may I say, teachers being teachers, soon found quasi-justification for the common practice which had developed and by the late 40s chiropodial bench text was full on non-science nonsense to which all UK and Commonwealth training practitioners had to become proficient. Until the 60s and 70s there was little reason to question the practices which had become part of the culture. Indeed it was considered taboo to do so (note the complete absence of published scientific enquiry during the first part of the 20th century). In the 50s and 60s it became a high priority to incorporate all manner of shapes and materials into established padding (e.g. foams and felt) . Never however with scientific led enquiry, only by pragmatism making what was done in the passed better (usually for the practitioner and not necessarily for the patient). The old justifications were blindly and unquestionably transferred onto the foam-o-felts etc.,. At first the biggest innovation was the introduction of the replaceable pad assisted by the introduction of tubular gauze. Then when much later, hypoallergic plastics were introduced this sidelined the replaceable practice and greater focus fell on anatomical prescriptions

    It was only with acceptance of gait analysis and pressure/force plate was the scientific means available in the 90s to understand ground force reactions etc., that it became possible to test the theories underpinning the traditional practice of foot padding. Of course as we now all know there is no substance to support the earlier claims, yet it appear we still teach gobbledegook.

    If a half life of a medical fact is 25 years , then maybe by the middle of this century educators can get a better understanding of scientific led principles and practice of padding and strapping.

    I have my doubts

    toeslayer
     
  15. wdd

    wdd Well-Known Member

    Keep it coming Toeslayer. Why do you doubt it?

    Best wishes,

    Bill
     
  16. davidh

    davidh Podiatry Arena Veteran

    I liked my PMPs. Admittedly, they didn't do much in the way of supporting that pesky transverse arch, but they helped some feet to interface with the shoe and ground better - at least that's what my private patients told me (not in those words obviously).

    Remember too that chiropodists were not the only ones fixated on solutions based on shaky/no science.
    Our NHS was delighted to fit dome pads ad-nauseum to arthritic patients, often on the say-so of Orthopaedics.
     
  17. Dieter Fellner

    Dieter Fellner Well-Known Member

    David,

    This entrenched part of my work <the sticky pad> made me feel better too. The problem, with asking a patient, is they often don't want to offend.

    As stated, a lot of the sticky pads end up in the trash, and all too often, all too soon. The acid test, I guess, is to know if a patient will want to pay, extra, for the stuck on pad. Or would they politely decline. Many of our orthopedist colleagues know less still about our pads, or how this may or may not be of assistance, but it's < nice > they would recommend such an option.

    In the case of the arthritic patient we are of course effecting a different clinical objective. Cushioning, pressure dispersion or joint motion modification might significantly improve arthritic pain.
    One of the startling observations, over the years, is how the introduction of F-scan technology has impacted on the delivery of mechanical therapy. When evaluated, in this way, the anticipated effects were absent. And the addition of others can provide unexpected beneficial effects when this cannot be predicted, based on conventional teaching and practice.

    I would also often use the adhesive pad as a trial, temporary orthotic device to know better if this treatment plan might help. The principal then to be transferred to a permanent insole or other custom orthotic device. Many, of course, still do so.
     
  18. markjohconley

    markjohconley Well-Known Member

    Is the added dorsiflexion mid-tarsal / rearfoot moments from forefoot padding relevant for consideration?
     
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